Re: My Husband, 43 yrs. old was just dx with prostate ca, gleason score of 6

Thanks, I've added your questions to ask the urologist (and 2nd opinion doctor). At this point, the 4 out of 6 cores is what is concerning me. Given that the prostate gland is about the size of a walnut in a normal man, it doesn't seem like that big of a gland in comparison to other cancers that strike major glands/ organs. It could be that had they taken 12 samples, he could have had 50% or less positive for cancer. I've also add the pomegranate and vitamins to my grocery list, he (and I) need to start eating healthier. He doesn't eat a whole lot of red meat (rarely) and pork is rare too. He does however, need to cut back on saturated fat. So much too think about.
Kcon, congratulations to your daughter on her graduation
sbear

Re: My Husband, 43 yrs. old was just dx with prostate ca, gleason score of 6

Quote:

Originally Posted by sbear1102

Please, anyone who can offer any input or information. My husband had a high PSA level a month ago (over 5). I wanted him to get a level b/c of his frequent trips to the bathroom. The report came back today, I'm not a doctor, but it shows 4 out of 6 specimens positive: specimen b: malignant (3+3) =6 PTI: 20% specimen c: Malignant (3+3)= 6 30% specimen e: malignant (3+3)= 6 20% specimen f maligant (3+3)=6 15%

based on the above, and the his age (he will be 44 this Aug), should he have his prostate removed or radiation? Has anyone know or personally experienced prostate ca at this age? Please help with any information, thank you.

Although I am older (69) I enjoy a very active and physical life. My PSA was 6.1 and had a Gleason of 3+4. April 3, 2009 I had my prostate surgically removed, the catheter 6 days later and never had an incontinence issue (threw away the diapers after two days). 2 months later the rest of the plumbing is working at a 7 out of 10 and definitely improving every week. Importantly, the pathology report showed ALL the cancer was confined to the removed prostate and I'm now cancer-free. My fitness level is all the way back and you can imagine that I feel great that it's behind me. Please encourage your husband to fully educate himself on the side effects of both surgery and radiation....neither one is without issue and I don't think you escape anything in terms of the potential side effects. For me, surgery every time because the objective is to get rid of the cancer permanently and not have it re-occur because some of the radiation missed. There are also serious problems if surgery is required after radiation in the event that the cancer re-emerges. The best advice I can give if he does chose surgery is to lose any excess weight, get as fit as possible and tell the surgeon that you want his A game that day. It makes a difference. Best of luck!
Ed

Re: My Husband, 43 yrs. old was just dx with prostate ca, gleason score of 6

Quote:

Originally Posted by equation319

...For me, surgery every time because the objective is to get rid of the cancer permanently and not have it re-occur because some of the radiation missed....

It's wonderful that your results were so good- and you obviously made the correct choice. However, I don't think it's as simple to say that surgery is better because one might have a problem with radiation because it reoccurred with some cancer being "missed". I think that an argument for the opposite can be made in that radiation can target areas within and just beyond the prostate, thus potentially killing cancer cells that the surgery may have missed at the margin. In cases where cancer reoccurs, it's often because it had already spread beyond the prostate. Some that have surgery and still end up with some remaining cancer based on the post-surgical biopsy opt to have radiation of the prostate bed. Those patients then end up with two procedures, when perhaps choosing radiation in the first place could have provided equivalent results. In my case, I chose proton beam radiation two years ago and have been as pleased with the results as you are with your surgery...

Re: My Husband, 43 yrs. old was just dx with prostate ca, gleason score of 6

Clearly the choice is not going to be easy. I asked my husband what his worst fear was: that he has his prostate removed, he ends up incontinent and impotent, and the cancer is still there. I get depressed thinking about it. We are scheduled for a second opinion next Friday with a surgeon. I'm trying to understand what, if any add'l tests he can have done to detect if it is confined (w/ a high level of accuracy).

Re: My Husband, 43 yrs. old was just dx with prostate ca, gleason score of 6

Quote:

Originally Posted by sbear1102

Clearly the choice is not going to be easy. I asked my husband what his worst fear was: that he has his prostate removed, he ends up incontinent and impotent, and the cancer is still there. I get depressed thinking about it. We are scheduled for a second opinion next Friday with a surgeon. I'm trying to understand what, if any add'l tests he can have done to detect if it is confined (w/ a high level of accuracy).

Two comments- first being that a surgeon will most likely tell you to do surgery. That's a given.

Second, he can have an endorectal MRI with spectroscopy. It's a lot more accurate than a regular MRI- not done everywhere. Mine was done in the Mayo Clinic in Jacksonville after I started my proton radiation at the Univ of Florida Proton Therapy Institute. The initial MRI was suspicious (as to whether the cancer had gone up to or beyond the edge of the prostate). Upon getting the second, more accurate test, I got the assurance that it was in fact contained.

I had initially opted for surgery- and in my meeting with the doctor I had asked about a test such as this. His response was "we only do that for high risk cases". My issue with that response and practice is that one doesn't always know if it's high risk or not. Surgeons must like to go with the odds rather than wanting to check everything out-- that was not the case prior to my beginning my proton treatment- it's all part of the evaluation. If I had it to do again, I'd follow the same path.

Re: My Husband, 43 yrs. old was just dx with prostate ca, gleason score of 6

It's hard to make this choice, but once it's made, most of us feel great relief.

Quote:

Originally Posted by sbear1102

Clearly the choice is not going to be easy.

That's the flip side of having quite a few excellent options.

I asked my husband what his worst fear was: that he has his prostate removed, he ends up incontinent and impotent, and the cancer is still there.

That's quite unlikely with his case characteristics, but, if it happened, it's highly likely that radiation would be able to cure the cancer that remained.

I get depressed thinking about it.

Do you have any cancer patient/spouse support resources that are convenient? Being able to talk things out directly with others who understand what you are going through would probably let you feel a lot better. It has worked for many of us. Also, time itself can bring great relief. You and your husband are really still in the early weeks since his diagnosis. You are still focusing on the dire possibilities, which is understandable, rather than on his rather good case characteristics and prospects, including access to fine medical resources.

We are scheduled for a second opinion next Friday with a surgeon. I'm trying to understand what, if any add'l tests he can have done to detect if it is confined (w/ a high level of accuracy).

A Combidex scan in the Netherlands would certainly nail down whether there had been any spread to lymph nodes, a very likely first destination for metastases, in the very unlikely event that there has been any spread of viable prostate cancer. The Prostate Cancer Research Institute has published some excellent information about Combidex in a recent issue of its newsletter, PCRI Insights. Another excellent choice for further determining the nature of the disease in the prostate and nearby would be an endorectal MRI with spectroscopy.

Re: My Husband, 43 yrs. old was just dx with prostate ca, gleason score of 6

Sorry aged 51 when dx now 56. Nothing has been conclusive re advanced PC. If I were to be given the chance to choose again, I would choose as I have, time and time again. There are very good reports of surgeons who remove using robots and have retained all functions successfully. So investigate thoroughly, new proceedures are there.

Re: My Husband, 43 yrs. old was just dx with prostate ca, gleason score of 6

Quote:

Originally Posted by sbear1102

Please, anyone who can offer any input or information. My husband had a high PSA level a month ago (over 5). I wanted him to get a level b/c of his frequent trips to the bathroom. The report came back today, I'm not a doctor, but it shows 4 out of 6 specimens positive: specimen b: malignant (3+3) =6 PTI: 20% specimen c: Malignant (3+3)= 6 30% specimen e: malignant (3+3)= 6 20% specimen f maligant (3+3)=6 15%

based on the above, and the his age (he will be 44 this Aug), should he have his prostate removed or radiation? Has anyone know or personally experienced prostate ca at this age? Please help with any information, thank you.

This past Tuesday I had a robotic prostatectomy using the Intuitive Surgical DaVinci system.

After all of my research on seeds, External Beam Radiation Therapy, High Intensity Ultrasound, my wife and I opted for the robotic surgery. The surgery lasted 1.25 hours, and according to my surgeon, it could not have gone better.

Each patient and each case is different and unique and a number of variables are considered regardless of which option you look at. Specifically; age, general health, life expectancy and any other underlying illnesses which may make a person a better candidate for one procedure over another.

According to my surgeon, in my particular case, surgery was my best option as I am 56 years old and generally in excellent health.

My advise to you you would be to research each option and weigh the pros and cons of each, considering your husband's age as well as his general health.

Re: My Husband, 43 yrs. old was just dx with prostate ca, gleason score of 6

Thank you all for responses. Cancervive, we are considering surgery. My husband watched the procedure (robotic) on line and was a bit scared. I have heard good things about it too. Did they, at some point, remove and biopsy some of the surrounding lymph nodes prior to operating? My friend's husband had open surgery for radical prostatectomy at John Hopkins 9 yrs. ago. They didn't proceed w/surgery until it was confirmed that his surrounding lymph nodes were neg. for cancer. At the time of his procedure, laparascopy and robotic was not as widely used. They had the results back almost right away. Do you know the rationale for this? Yes, there are different options to consider. My husband spoke with someone in S. Carolina who opted to hav HIFU in the Bahamas. He touted this as the way to go, and discouraged him from a radical prostatectomy, stating he has known many who have gone this way and now have incontinence, etc. I was concerned he would receive negative unsolicited feedback on those partial to this or that. Personally, I think robotic surgery- or laparoscopic hands on surgery might be the way to go. That is, if we can ascertain it hasn't spread outside the prostate. I guess he could have f-up radiation if this were the case. He had a rectal ultrasound (not sure if it was spectroscopy) initially during his biopsy. They said his prostate was quite normal in size, and the report read "benign seminal vesicle tissue". They said it was a "portion" so, I guess it is not 100% accurate. Too bad they don't have Combivex over here like they do in the Netherlands, it sounds like a good clinical diagnostic tool.

Re: My Husband, 43 yrs. old was just dx with prostate ca, gleason score of 6

Quote:

Originally Posted by sbear1102

Do you know the rationale for this?

Hi again, sbear. I hope that you & your husband are doing better. My first several weeks after dx were filled with fear, panic, etc, but once I realized that I wasn't going to die from my low-risk case of PC, I got more rational about thinking about what to do next. I hope you are similarly progressing down the road...sounds like you are getting well educated.

If I recall, your husband has a 2nd opinion appointment coming up soon. Here’s my understanding on the lymph node biopsy rationale question, but you should run this by the doc in that appointment to confirm this point…I’d be interested in knowing his response, and whether it's similar or different than mine, but I would comment that I think there is some room for individual doctor habit/judgement/protocol variation.

Generally, if the doctor is highly suspicious that the cancer may have spread (due to high PSA levels or a high Gleason score), then he may remove a lymph node sample for biopsy. This could be done in a surgical procedure before RP surgery, or during as you have described. If no cancer is found, then surgery is then completed as planned. If cancer is found in the lymph nodes, however, then usually the surgery is stopped without removing the prostate. This is due to the fact that, if the cancer has already spread outside the prostate, removal adds little benefit to the patient. But you already knew all this…

The variable part is in the first sentence from the paragraph above: “if the doctor is highly suspicious that the cancer may have spread (due to high PSA levels or a high Gleason score)…” Your husband does not have what would be generally considered a high PSA score at 5.03 (yes, higher than a non-PC patient, but low among PC patients), and has a low Gleason score 3+3=6. (In fact I’ve seen discussion about how urologists are starting to not even speak about anything lower than 6; therefore, 6 would effectively be the lowest score in the PC world.)

The American Cancer Society site states: “Lymph node biopsies are rarely done unless your doctor is concerned that the cancer has spread.” (I added the underlining for emphasis. I think the "rarely" part has to do with the individual doctor hobit/judgement/protocol variation I spoke of earlier.)

I've heard more than once about some docs who do the “open” procedure doing biopsy no matter what. This was the case with the surgeon I met with who did “open” method…despite my low-risk clinical stage, he does the during surgery biopsy with everyone. (I ended up going with a different surgeon, but not for this reason.)

Anyhow, great question to clarify this rationale in your upcoming appointment.

best wishes...

By the way, you've made an astute observation in your post, below: "I was concerned he would receive negative unsolicited feedback on those partial to this or that." I'm sure you can see how it would be quite natural for some to become evangelists/disciples for a particular procedure which has been successful for them, perhaps passionately conveying their personal views...some might even write books about it. Continue to be your own judge for your own (your husband's own) unique set of personal circumstances.

Re: My Husband, 43 yrs. old was just dx with prostate ca, gleason score of 6

Quote:

Originally Posted by sbear1102

Thank you all for responses. Cancervive, we are considering surgery. My husband watched the procedure (robotic) on line and was a bit scared. I have heard good things about it too. Did they, at some point, remove and biopsy some of the surrounding lymph nodes prior to operating? My friend's husband had open surgery for radical prostatectomy at John Hopkins 9 yrs. ago. They didn't proceed w/surgery until it was confirmed that his surrounding lymph nodes were neg. for cancer. At the time of his procedure, laparascopy and robotic was not as widely used. They had the results back almost right away. Do you know the rationale for this? Yes, there are different options to consider. My husband spoke with someone in S. Carolina who opted to hav HIFU in the Bahamas. He touted this as the way to go, and discouraged him from a radical prostatectomy, stating he has known many who have gone this way and now have incontinence, etc. I was concerned he would receive negative unsolicited feedback on those partial to this or that. Personally, I think robotic surgery- or laparoscopic hands on surgery might be the way to go. That is, if we can ascertain it hasn't spread outside the prostate. I guess he could have f-up radiation if this were the case. He had a rectal ultrasound (not sure if it was spectroscopy) initially during his biopsy. They said his prostate was quite normal in size, and the report read "benign seminal vesicle tissue". They said it was a "portion" so, I guess it is not 100% accurate. Too bad they don't have Combivex over here like they do in the Netherlands, it sounds like a good clinical diagnostic tool.

In my particular case, I had a prostate biopsy done first. Of the 12 cores taken, 4 came back positive. A week later I had a chest, abdominal and pelvic CT along with a full body nuclear bone scan. All show that the cancer was localized to the prostate.

According to my surgeon, Dr. Nikhil Shah, during the robotic surgery, he did indeed remove some of the surrounding lymph nodes for pathological analysis to ensure the cancer was indeed localized to the prostate.

I am now 5 days post surgery, and the only discomfort I am experiencing is catheter irritation.

Good luck with your decision making process, and if you would like to talk privately just let me know and I can give you my contact information.

Re: My Husband, 43 yrs. old was just dx with prostate ca, gleason score of 6

Hi Sbear,
I note that you are trending towards surgery as an option. If so you may want to google "Cavermap". It's essentially a nerve sparing procedure that identifies and hopefully isolates the important nerves that deal with tumessence (erectile function), prior to the removal of the prostate and any surrounding tissues. Before closing the incision the nerves are re-tested to ensure their function is still viable. Some studies have indicated that nerve-sparing techniques such as the Cavermap have increased the return of full sexual function from 50 % to 70%, in particular in men of your husbands age. My surgeon visited me in recovery and assured me that the nerves were working perfectly both before and after the surgery, and that was indeed a big physcological boost! To repeat my earlier comment, I never had an incontinence issue and the rest of the plumbing is working at a good 7 out of 10, but improving weekly. By the way, I was diagnosed March of 2008 with almost the same numbers as your husband (PSA 6.1, Gleason 3+4, 4 of 12 cores malignant) but after considering active surveilence (I'm 69 years old), brachytherapy and radiation, eventually decided on surgery in April of 2009.....shoulder season between skiing and golf! The surgery is absolutely no fun but 29 days later I played in our club's "cinqo de mayo" (sp?) golf tournament and was back working out with a personal trainer. There's no question in my mind that most of us fare a lot better than we worry about and that we recover quickly and successfully from the "indignities to the plumbing system". When I look back I think that recovery really starts with making that decision (whether surgery, radiation, etc.) because now you at least feel that you are in charge of the disease and are doing something about it.
Best of luck with you and your husband's journey!
Ed

Re: My Husband, 43 yrs. old was just dx with prostate ca, gleason score of 6

Thanks again for your responses. I will be going with my husband to second opinion this Friday and will bring up some of these points. I'll keep you posted on how things go. (Husband had another PSA drawn today).